Mandatory
forms
Councillor induction pack 2019
Local Elections 2019
wel ington.govt.nz/elections
The information in this booklet
needs to be returned to ensure
you are set up correctly in the
Council systems.
Please return the signed booklet to
Elected Member Support Team by
23 October 2019.
Please use the pre-paid envelope
to send back the booklet to us.
Alternatively, you could drop it
in person at Council office:
113 The Terrace (Tahiwi)
Wellington
If you need assistance please
contact
Crispian Franklin
Phone
Mobile
Elected Members Sign on Form
Personal details
Salutation:
Mr
Mrs
Miss
Ms
Dr
Hon
Sir
Dame
Other:
Full name:
Preferred name:
Partner’s name:
Personal details
Mailing Address
Apartment / Unit / PO Box Number:
Street Number:
Street Name:
Suburb or RD Number:
City:
Postcode:
Residential
Apartment / Unit / PO Box Number:
Address
If diff erent from
Street Number:
Street Name:
above; used for
courier mail
Suburb or RD Number:
City:
Postcode:
Courier
Instructions:
Are there any special delivery instructions for courier deliveries?
Including courier deliveries outside of normal working hours e.g. leave at backdoor?
Home telephone:
Work telephone:
Mobile number:
Email address:
Vehicle Details (Mayor and Councillors Only)
This information is required for the use of the Basement Carpark at WCC
Make:
Model:
Registration:
Colour:
Make:
Model:
Registration:
Colour:
Make:
Model:
Registration:
Colour:
Elected Members are assigned with only one car park
CSWCCJ001647
Withholding Tax Payment
DATE OF SERVICE
To determine if you should be deducting withholding tax you need to establish if the nature of the payment falls under the Income
Tax (
Withholding Payments) Regulations. The easiest way to do this is to refer to the back of the IR330 Tax Code Declaration form.
If you are in a group of musicians or band, you may nominate a spokesperson for the payment of the whole group, otherwise each
member will need to complete an individual IR330 Tax form and Withholding Tax Payment form.
Personal details
Full name:
Address:
Home telephone:
Work telephone:
Name of Bank:
Bank Account Number:
–
–
–
IRD Number:
–
–
GST Registered?
Yes
No
To be Taxed at the Rate of Cents:
Tax Code:
WT
Brief description of services provided:
Gross Amount to be paid:
$
Business Unit Manager to Complete
Business Unit Name:
Cost Centre:
Project Code:
PAY AUTHORISATION:
Signature:
Name:
Designation:
Gross Amount (
WHT)
$
Plus 15% GST (
GST)
$
GST inclusive
$
Less Withholding Tax
$
Net Payment
$
CSWCCJ001648
Deposit slip or bank statement
CONFIDENTIAL
Deposit Slip or Bank Statement
Please attach a copy of a deposit slip or bank statement of your designated bank account here:
Passport
Please attach a copy of your passport. This is required for any travel that may be taken during your term
If you are an AirNZ frequent fl yer member, please write your number here:
CSWCCJ001653
IR330
Tax code declaration
May 2016
Employer
Do not send this form to Inland Revenue. You must keep this completed IR330 with your business
records for seven years following the last wage payment you make to the employee.
Employee
When you have completed your IR330, give it to your employer.
1 Your details
First name/s (in full)
Family name
IRD number
(8 digit numbers start in the second box.
)
If you don't know your IRD number or you don't have an IRD number, call us on 0800 227 774.
If you want to pay your child support through your employer, talk to us on 0800 221 221 and we can set that up for you.
Are you a KiwiSaver member? New employee - complete the KS2. Existing KiwiSaver member - complete the KS2 to start deductions.
2 Your tax code
You must complete a separate Tax code declaration (IR330) for each source of income
Choose only ONE tax code Refer to the flowchart on page 2 and then enter a tax code here.
If you're a
casual agricultural worker, shearer, shearing shedhand, recognised seasonal worker, election day worker, have a
special
tax code or are receiving
schedular payments, refer to “Other tax code options” at the bottom of page 2, choose your tax code and
enter it in the tax code circle.
If your tax code is ”WT” write your schedular
payment activity from page 4 here.
3 Your entitlement to work
I am entitled under the Immigration Act 2009 to do the work that this tax code declaration relates to (tick the box that applies to you).
I am a New Zealand or Australian citizen or am entitled to work indefinitely in New Zealand.
I hold a valid visa with conditions allowing work in New Zealand.
Find out whether you are entitled to work in New Zealand by calling 0508 558 855 or 09 914 4100.
Your employer can check your work entitlement status through VisaView
www.immigration.govt.nz/visaview if they are registered for this
service, or by calling Immigration New Zealand on one of these numbers:
Auckland toll-free calling area
09 969 1458
Wellington
04 910 9916
Other parts of New Zealand
0508 WORK NZ
Your employer may also ask you for additional evidence about your entitlement to work status.
Note to employers: It is an offence to employ someone who is not entitled to work under the Immigration Act 2009. An employer has a defence
if the employer did not know the person was not entitled to work, took reasonable precautions and exercised due diligence to ascertain whether
the person was entitled to do the work. Relying solely on this IR330 form does not constitute reasonable precautions or due diligence. Instead,
employers may check entitlements using the online VisaView service (
www.immigration.govt.nz/visaview) or by contacting Immigration
New Zealand or by seeking documentary evidence.
4 Declaration
Signature
2 0
Day
Month
Year
Please give this completed form to your employer. If you don't complete Questions 1, 2 and 4, your employer must deduct tax from your pay at
the no-notification rate of 45 cents (plus earners' levy) in the dollar. For the no-notification rate on schedular payments see the table on page 4.
Privacy
Meeting your tax obligations means giving us accurate information so we can assess your liabilities or your entitlements under the Acts we
administer. We may charge penalties if you don't.
We may also exchange information about you with:
RESET FORM
• some government agencies
• another country, if we have an information supply agreement with them
• Statistics New Zealand (for statistical purposes only).
If you ask to see the personal information we hold about you, we'll show you and correct any errors, unless we have a lawful reason not to.
Call us on 0800 377 774 for more information. For full details of our privacy policy go to
www.ird.govt.nz (keyword: privacy).
Salary and wages – main or highest source of income
Choose your tax code here if you receive salary or wages. See secondary income and other tax code options below for secondary jobs or income
from other sources
Do you
receive an
Is this tax
income
code for
No
Are you a
Yes
tested
your main
New Zealand
benefit?
or highest
tax resident?
source of
– see note 3
income?
No
Yes
Yes
Is this tax
code for
M SL
the income
No
tested
Read
Yes
Is your annual income likely
benefit?
note 1
to be between $24,000 and
No
Do you have
a New Zealand
$48,000? – see note 4
student loan?
No
Yes
M
No
Yes
Yes
Are you or your partner entitled
to Working for Families Tax
M
Read note
Credits or an overseas equivalent
1
or do you receive NZ Super,
veteran's pension or an overseas
equivalent? – see note 5
No
Do you have a
New Zealand
student loan?
Yes
No
ME SL
ME
Secondary income
Use this flow chart for your secondary income source
Other tax code options:
Read
Is your annual
Do you
SB SL
Use the tax code shown if you receive any of the
note 6
income from all
have a
Yes
following types of income or you have a special tax code
sources likely to be
Yes
student
less than $14,000?
loan*?
SB
No
No
Casual agricultural workers,
shearers or shedhands
CAE
Read
(see note 7)
Do you
S SL
Is your annual
note 6
Yes
income from all
Yes
have a
sources likely to be
student
Election day workers
EDW
between $14,001 and
loan*?
S
No
$48,000?
No
SH
Do you
Yes
SL
Recognised seasonal workers
have a
(see note 8)
NSW
Is your annual
Yes
student
income from all
loan*?
SH
sources likely to be
No
Schedular payments
between $48,001 and
(see note 9)
WT
$70,000?
Yes
ST SL
Do you
No
have a
student
Special tax code
loan*?
ST
(see note 10)
STC
No
* Relates to New Zealand student loans only
When you've worked out your tax code, enter it in the tax code circle at Question 2 on page 1.
2
Important: You may need to change your tax code if your circumstances change during the year. For example:
– you take out a student loan or pay it off
– start or stop being eligible to use ME or ME SL (see note 5 below)
– you have a second job and your income decreases or increases, changing the code you should be using.
Notes to help you complete this form
1. If you receive a
benefit from Work and Income (other than a student allowance, NZ super or veteran's pension) it is treated as your
highest source of income and you must use the
“M” tax code for this income.
You must use the secondary income section on
page 2 to work out your tax code for any other taxable income.
If you choose a secondary tax code of
“S” or
“S SL” and you'll earn more from your secondary job than your benefit, you may pay
more tax than you're required to for that job. You can apply for a
special tax code so that the right amount of tax is deducted – read
note 10 for more information about special tax codes.
2.
Source of income means income such as salary, wages, weekly accident compensation payments, NZ Super, veteran's weekly
compensation, veteran's pension or student allowance.
3. You are a New Zealand tax resident in any of these situations:
• You've been in New Zealand for more than 183 days in any 12-month period and haven't become a non-resident.
• You have a permanent place of abode in New Zealand.
• You're away from New Zealand in the service of the New Zealand Government.
4. Your
annual income is your total income (before tax is deducted) from all sources, from 1 April to 31 March, excluding losses carried
forward from a previous year.
5. If you or your partner are entitled to receive WfFTC or an overseas equivalent, or if you receive NZ Super, veteran's pension or an
overseas equivalent of any of these, your tax code is
“M” (or
“M SL” if you have a student loan). You're not eligible to use
“ME” or
“ME SL”.
For more information about WfFTC go to
www.ird.govt.nz
6. You may be eligible for a repayment deduction exemption on your salary and wage income if you:
• have a student loan
• are studying full-time in New Zealand
• expect to earn below the annual repayment threshold from all sources
• earn above the pay-period repayment threshold.
If you have a student loan and you choose
“SB SL” or
“S SL” for your tax code, you may pay more towards your student loan than
you need to. If you earn under the pay period repayment threshold, eg, $367 a week from your main job, you can apply for a special
deduction rate to reduce your student loan repayment deductions on your secondary earnings.
For more information about repayment deduction exceptions and special deduction rates go to
www.ird.govt.nz/studentloans
If you already have a repayment deduction exception or special deduction rate for your student loan but your circumstances have
changed, you'll need to update your details so we can check you're still eligible. You can do this at
www.ird.govt.nz or by calling
0800 227 774.
7.
Casual agricultural workers are people engaged in casual seasonal work on a day-to-day basis, for up to three months. This includes
shearers and shearing shedhands.
8. If you are a recognised seasonal worker or hold a work visa as foreign crew of a vessel fishing New Zealand waters, you will use the
“NSW” code.
Recognised seasonal workers must be employed by a registered employer under the Recognised Seasonal Employers'
Scheme and are employed in the horticulture or viticulture industries. You must have a visa and/or a permit issued under the
Recognised Employer Work Policy. See
www.dol.govt.nz (search keyword: seasonal).
9.
Schedular payments are for contract work, not salary or wages. ACC personal service rehabilitation payments paid by ACC or an
accredited employer are schedular payments. You'll need to find your schedular payment activity on page 4 and write this in the
space provided in Question 2 on page 1.
ACC personal service rehabilitation payments include attendant care, home help, childcare, attendant care services related to
training for independence, attendant care services related to transport for independence, paid under the Injury Prevention and
Rehabilitation Compensation Act 2001.
10. If you have a current
special tax code certificate, show
“STC” as your tax code on page 1 and attach a copy of your special tax code
certificate to this declaration form.
A special tax code is a tax deduction rate worked out to suit your individual circumstances. You may want one if the regular tax
codes will result in you not paying enough tax or paying too much. For example if you have a rental property, business losses, income
that doesn't have tax deducted before you receive it, you receive payments from either ACC or an ACC client for providing ACC
personal service rehabilitation care and you expect to earn over $14,000 from all sources, or if you're on a benefit and working. Go to
www.ird.govt.nz or call us on 0800 227 774 for more information. You can get a
Special tax code application (IR23BS) from our website or
by calling 0800 257 773. Please have your IRD number handy.
Note If you need help choosing your tax code please go to www.ird.govt.nz or call us on 0800 227 774.
3
Rate of tax deductions from schedular payments
Schedular payments are not for employees, they are for people who are independent contractors. All ACC personal service rehabilitation
payments which are paid by ACC are classified as schedular payments. These payments are taxed at flat rates. If you are receiving payment for any
of the types of work listed below on contract, enter the activity name in the box at Question 2 on page 1.
Your tax code will be “WT”, which means you'll be required to file an
IR3 tax return at the end of the financial year. ACC clients or carers
receiving ACC personal service rehabilitation payments may not be required to file an IR3. If you receive schedular payments you will receive an
invoice for your ACC levies directly from ACC.
Activity
Normal tax Rate if no tax
rate
code declared
ACC personal service rehabilitation payments (attendant care, home help, childcare, attendant care services
related to training for independence and attendant care services related to transport for independence) paid
under the Injury Prevention and Rehabilitation Compensation Act 2001.
10.5c
25.5c
Agricultural contracts for maintenance, development, or other work on farming or agricultural land (not to be
used where CAE code applies)
15c
30c
Agricultural, horticultural or viticultural contracts by any type of contractor (individual, partnership, trust or
company) for work or services rendered under contract or arrangement for the supply of labour, or substantially
for the supply of labour on land in connection with fruit crops, orchards, vegetables or vineyards
15c
30c
Apprentice jockeys or drivers
15c
30c
Cleaning office, business, institution, or other premises (except residential) or cleaning or laundering plant,
vehicles, furniture etc
20c
35c
Commissions to insurance agents and sub-agents and salespeople
20c
35c
Company directors' (fees)
33c
48c
Contracts wholly or substantially for labour only in the building industry
20c
35c
Demonstrating goods or appliances
25c
40c
Entertainers (New Zealand resident only) such as lecturers, presenters, participants in sporting events, and radio,
television, stage and film performers
20c
35c
Examiners (fees payable)
33c
48c
Forestry or bush work of all kinds, or flax planting or cutting
15c
30c
Freelance contributions to newspapers, journals (eg, articles, photographs, cartoons) or for radio, television
or stage productions
25c
40c
Gardening, grass or hedge cutting, or weed or vermin destruction (for an office, business or institution)
20c
35c
Honoraria
33c
48c
Modelling
20c
35c
Non-resident entertainers and professional sportspeople visiting New Zealand1
20c
N/A
Payments for:
– caretaking or acting as a guard
15c
30c
– mail contracting
15c
30c
– milk delivery
15c
30c
– refuse removal, street or road cleaning
15c
30c
– transport of school children
15c
30c
Proceeds from sales of:
– eels (not retail sales)
25c
40c
– greenstone (not retail sales)
25c
40c
– sphagnum moss (not retail sales)
25c
40c
– whitebait (not retail sales)
25c
40c
– wild deer, pigs or goats or parts of these animals
25c
40c
Public office holders (fees)
33c
48c
Sharefishing (on contract for the supply of labour only)
20c
35c
Shearing or droving (not to be used where CAE code applies)
15c
30c
Television, video or film: on-set and off-set production processes (New Zealand residents only)
20c
35c
If you are a non-resident contractor receiving a contract payment for a contract activity or service and none of the
above activities are applicable, then:2
Non-resident contractor (and not a company)
15c
30c
Non-resident contractor (and a company)
15c
20c
1 The following may be entitled to exemption from tax:
–
non-resident entertainers taking part in a cultural programme sponsored by a government or promoted by an overseas non-profit
cultural organisation
–
non-resident sportspeople officially representing an overseas national sports body.
Send applications for exemption to:
Team Leader, Non-resident Entertainment Unit, Large Enterprises Assistance, PO Box 5542, Wellesley Street, Auckland 1141, New Zealand.
Fax 09 984 3082
2 Applications for exemption certificates or enquiries about non-resident contractors should be sent to:
Team Leader, Non-resident Contractors Team, Large Enterprises Assistance, PO Box 2198, Wellington 6140 New Zealand.
Phone 64 4 890 3056 Fax 64 4 890 4502
4
Note If you need help choosing your tax code please go to www.ird.govt.nz or call us on 0800 227 774.
Register of interests
CONFIDENTIAL
As part of the Annual Report process, all Councillors are asked to update their confl ict of interest declarations and declare any
transactions with related parties. This information is required to be disclosed in the Annual Report. We have changed the usual
form to incorporate details on any related party transactions that need to be declared. The list of Confl icts of Interest is made
publicly available on the Council’s website.
Examples of where interests can give rise to a potential confl ict of interests are:
• Being an employee, advisor, director or partner of another business or organisation;
• Pursuing a business opportunity;
• Being a member of a club, society or association;
• Having a professional or legal obligation to someone else (such as being a trustee);
• Owning or occupying a piece of land;
• Owning shares or some other investment or asset;
• Having received a gift, hospitality, or other benefi t from someone;
• Being a relative or close friend of someone who has one of these interests.
Your Council made appointments to outside organisations, Boards and Trusts will be included after appointments have been made.
In the following table please state any fi nancial interests (
e.g. ownership/share of a company; director/trustee of a trust; business
dealings or interests that could give rise to, or do involve, a contract with the Wellington City Council; ownership of property;
employment)
you have and
your relationship to that interest:
Interest
Relationship
(
e.g. owner, director, employee, trustee)
* Further declarations can be made over the page.
In the following table please state any fi nancial interests (
e.g. ownership/share of a company; director/trustee of a trust; business
dealings or interests that could give rise to, or do involve, a contract with the Wellington City Council; ownership of property;
employment) your
spouse/partner has and
his/her relationship to that interest:
Interest
Relationship
(
e.g. owner, director, employee, trustee)
* Further declarations can be made over the page.
1
CSWCCJ001649
Interest
Relationship
(e.g. owner, director, employee, trustee)
Declaration for your spouse/partner:
Interest
Relationship
(e.g. owner, director, employee, trustee)
Declaration
I have read and understood the
Confl ict of Interest Guidelines, and have stated all of my and my spouse/partner’s fi nancial
interests which may lead me to have a confl ict of interest in my role as an elected member.
Signature:
Name:
Date:
Declaration for you:
2
New & Replacement Access/ID Card Application Form
Your information and photo is collected for physical and System Security Identification purposes.
Employee Details
(please print in capitals)
First Name:
Directorate/Company:
Last Name:
Position:
BU:
Team:
Phone:
New or Existing ID Cardholder
New card
attach named jpeg photo
Note: To opt out of using your security photo
for internal systems i.e Pokapu, Jabber.
Replacement Card
Please tick here
(
return OLD card if not lost)
Please use the below requirements to capture the correct photo of new staff or contractors.
• White/pale background ONLY
• Not up against the wall but a least one metre gap
• Prescription glasses only
• Plenty of room all the way around the person – includes the top
• No close up
• No hats of any type
• No sunglasses anywhere on head
• No selfies
• A nice smile would be good
• Clear not blurry
• Jpeg format
Cardholder Update
(Please return your existing cards, if not lost)
Change to personal details
Change to access required
Select Template
Staff
MOW
NZSO
Contractor (City Care, Spotless, DD etc)
CGW
Wgtn I-Site
(Attach copy of Contractor Health & Safety Induction
Capital E
Wgtn Zoo
checklist for contractors only)
1
J007295
Access Required
(please print in capitals)
Suitable for contractors
7am–7pm
Other
or casual staff.
8am–5pm
Remote Site Access:
State which site/building and
113 The Terrace and Civic (HID Cards) can only be programmed for staff working
floor you work on?
at 113 The Terrace
Satelite Site:
* Specify if any special
For other floors.
access required
e.g. Alarms, Double Swipe etc.
For Casual, Fix Term Contracts,
From:
To:
Contractors, specify dates:
Employee
(Please allow up to THREE working days for new/replacement cards to be issued.)
PLEASE NOTE: If you are in possession of an access card, when you submit this form, will automatically DEACTIVATE when
the new card is created.
I understand I am responsible for keeping this card safe and agree to the conditions of use as set out below. I also agree to immediately
report its loss or theft to Security on
.
Conditions of Use:
• Lost or stolen access cards should be reported to security
immediately so that these can be disabled to prevent fraudulent use;
• Cardholders need to ensure they do not allow access to unknown visitors* on their access card by swiping their own access card for them or
by lending their own access cards to others;
• All card access is recorded for audit and security purposes and the card holder is responsible for their own access cards and the areas
accessed by them;
• Council Access – ID cards must be DISPLAYED as a form of identification at all times.
*Visitors
All legitimate visitors need to be properly signed in and then escorted through to the work areas. Council staff are responsible for their own
visitors – especially in the event of an emergency where evacuation may be necessary.
Signed:
Date:
Approving Manager
Name:
Position:
Cost Code:
Activity Code:
Signed:
Date:
Check list
Form Fully Completed
Contractor Health and Safety Induction Completed for Contrators
Attached Named Jpeg Photo - (no hard copies accepted)
In one email send to [email address] – BUS: Security Management
2
Contractor health and safety Induction checklist
The Health and Safety at Work Act 2015 requires Council to ensure so far as is reasonably practicable, the health and safety of our workers
(including contractor and sub-contractor workers) and other people is not put at risk while doing any work the contractor has been engaged to
do. The Wellington City Council employee or nominated person will complete the following health and safety induction with any new contractors.
This document is the minimum standard requirements and may require further site specifications for individual business units.
WCC employee name:
Date:
Contractor name and company:
Council Site:
Health and Safety Checks:
Given an overview of the WCC Health and Safety Statement of Commitment (Policy)
Given an overview of or tour of the facility/site/location, including access, security, toilets, meal rooms
Facility/site/location health and safety responsibilities explained, including:
• Council contact person(s) / person(s) to report to
• Signing in and out of facility/site/location
Given an overview of the hazard management system, including:
• Council hazard identification procedure
• Hazards the contractors may encounter – refer to the site specific hazard register, including controls and safe
work practices
• Hazards the contractors may create – contractor identifies hazards and controls that may arise during the course of
their work
Given an overview of the incident reporting and investigation procedures – including the reporting of all accidents, near miss, unsafe
behaviour and unsafe equipment
Given an overview of the facility/site/location emergency procedures, including evacuation assembly point
Where applicable given an overview of hazardous substance procedures, including access to Safety Data Sheets
Location and proper use of Council safety equipment shown
Council’s Code of Conduct explained
Health & Safety Observations explained – Council will undertake these to monitor contractor H&S performance
Other
I acknowledge that the above information has been received and understood
Contractor name:
Contractor’s signature:
Date:
I acknowledge that the induction is complete – please sign and date
WCC Employee Name:
WCC Employee’s signature:
Date:
Form saved in contractors record in Risk Manager contractor module
3
J008923
